Real-World Outcomes in Treatment of Highly Calcified Coronary Lesions With Intravascular Shockwave Lithotripsy

Long‐term outcomes following intravascular lithotripsy (IVL) for calcified coronary lesions: A Real‐World Multicenter European Study

“…To our knowledge, this is the first real‐world, all‐comers, high‐risk population registry with long‐term follow‐up of patients who underwent treatment with IVL at eight high‐volume centers in Europe and the United Kingdom. Some observational studies have shown IVL to be an effective and safe treatment for calcific coronary lesions but in small patient cohorts, ranging from 50 to 70 patients as compared to our study of 273 patients 14,30,37 . Moreover, we treated a high‐risk population as evidenced by several comorbidities including diabetes in 40% (13% insulin dependent) and CKD in 17% of cases.…”

“…Coronary calcification may limit stent delivery and deployment and may result in stent under‐expansion, strut malapposition, and direct damage to the stent surface (including polymer), with potential impairment of drug delivery 9–13 . Moreover, stent under‐expansion has been shown to be a major determinant of stent thrombosis (ST) and in‐stent restenosis (ISR) 1,4,8,11,14 . Use of adjunctive devices such as specialized dedicated balloons (noncompliant, very high‐pressure, scoring, or cutting balloons), rotational and orbital atherectomy, and excimer laser catheters do aid in adequate lesion preparation and stent expansion, but this is at the expense of an increased risk of coronary perforation and dissection, which can be catastrophic 5,7,15–22 .…”

“…[9][10][11][12][13] Moreover, stent under-expansion has been shown to be a major determinant of stent thrombosis (ST) and in-stent restenosis (ISR). 1,4,8,11,14 Use of adjunctive devices such as specialized dedicated balloons (noncompliant, very high-pressure, scoring, or cutting balloons), rotational and orbital atherectomy, and excimer laser catheters do aid in adequate lesion preparation and stent expansion, but this is at the expense of an increased risk of coronary perforation and dissection, which can be catastrophic. 5,7,[15][16][17][18][19][20][21][22] Rotational and orbital atherectomy selectively ablate superficial calcium, which facilitates stent delivery.…”